Carotid ultrasonography for detection of vascular abnormalities in hypertensive children

Abstract

To determine whether hypertension and overweight status are associated with increased carotid intimal-medial thickness (cIMT) in children, vascular ultrasonography was performed in newly diagnosed hypertensive patients ( n=53) and normotensive controls ( n=33). Hypertensive subjects were identified either by referral or by systematic school-based hypertension screening. Hypertension was defined as blood pressure above the 95th percentile based on current Task Force criteria, and overweight was defined as body mass index (BMI) >25 kg/m(2). cIMT was assessed by high-resolution vascular ultrasonography of the distal common carotid artery. Hypertensive subjects had a higher cIMT than normotensive subjects (0.62 vs. 0.53 mm, P<0.00001). This difference remained significant after controlling for the effects of gender, race, age, height, weight, and BMI. Similarly, overweight subjects had a higher cIMT than normal-weight subjects (0.63 vs. 0.54 mm, P<0.0001). Subjects with both systolic and diastolic hypertension had higher cIMT than those with isolated systolic hypertension (0.67 vs. 0.60, P<0.05). cIMT showed significant positive pairwise correlation with age, height, weight, BMI, and systolic blood pressure. Among all clinical variables analyzed, cIMT was most strongly correlated with BMI ( r=0.53, P<0.001). These results provide further evidence that vasculopathy occurs in association with known cardiovascular risk factors such as hypertension and obesity during childhood.

Cardiovascular Risk Factors and Sequelae in Hypertensive Children Identified by Referral Versus School-Based Screening

“…We have previously reported significant positive associations between BMI and LVMI 2 and cIMT. 3 Of note, the current study found no association between raw or indexed blood pressure values and markers of hypertensive sequelae. Thus, an accumulation of evidence suggests that overweight may be the greatest risk factor for target organ changes in children with elevated blood pressure.…”

“…Because morbid cardiovascular events are rare except in the most severely hypertensive children, investigation has relied on surrogate markers of hypertensive injury such as left ventricular mass index (LVMI) and carotid artery intimal medial thickness (cIMT). Recent studies have shown that LVMI 2 and cIMT 3 are increased in hypertensive as compared with normotensive children and that these increases occur in parallel. 4 In hypertensive children, the reported prevalence of left ventricular hypertrophy (LVH) ranges from 10% to 38%, [5][6][7][8][9][10][11][12] depending on the echocardiography protocol used to derive LVM, the method of indexing LVM to standardize across the range of pediatric age and size, and the threshold used to define LVH in children.…”

Progress and Challenges in Metabolic Syndrome in Children and Adolescents

“…C-IMT in children was increased with type 1 diabetes mellitus 146,147 and hypertension. 148 A recent study in 79 healthy children 10.5Ϯ1.1 years of age showed that CRP was a significant independent predictor of C-IMT and flow-mediated vasodilation. 149 Others have shown that adolescent offspring of adults with premature ASCVD had increased C-IMT and abnormal flow-mediated vasodilation compared with control subjects.…”

Effects of Childhood Primary Hypertension on Carotid Intima Media Thickness

“…10,11 Recent studies have investigated whether cIMT is also increased in childhood primary hypertension. [12][13][14][15][16][17] However, these reports have been confounded by the high proportion of hypertensive subjects with obesity, itself an independent risk factor for increased cIMT. 18 -22 Consequently, after adjusting for body mass index (BMI), previous studies have been inconsistent in showing increased cIMT in hypertensive children and have failed to demonstrate office blood pressure (BP) as an independent predictor of cIMT.…”